The Society of Thoracic Surgeons Practice Guidelines on the Role of Multimodality Treatment for Cancer of the Esophagus and Gastroesophageal Junction

1. Class I Recommendation: Patients with potentially curable, locally advanced esophageal cancer should be cared for in a multidisciplinary setting. (Level of Evidence B) 2. Class I Recommendation: Restaging studies after neoadjuvant therapy are recommended before resection to rule out interval development of distant metastatic disease. (Level of Evidence B) 3. Class IIA Recommendation: Endoscopic ultrasound restaging for residual local (mural) disease is inaccurate and can be omitted. (Level of Evidence B) 4. Class IIA Recommendation: A positron emission tomography scan is recommended for restaging after neoadjuvant therapy to detect interval development of distant metastatic disease. (Level of Evidence B) 5. Class III Recommendation: Radiotherapy as monotherapy before resection is not recommended. (Level of Evidence A) 6. Class IIA recommendation: Neoadjuvant platinumbased doublet chemotherapy alone is beneficial before resection for patients with locally advanced esophageal adenocarcinoma. (Level of Evidence A) 7. Class IIA Recommendation: Neoadjuvant chemoradiation therapy should be used for locally advanced squamous cell cancer and either neoadjuvant chemotherapy or chemoradiation therapy for locally advanced adenocarcinoma; multimodality therapy has advantages over surgical resection alone. (Level of Evidence A) 8. Class I Recommendation: After neoadjuvant therapy, patients without metastatic disease, in whom surgical resection can be safely performed, should receive esophageal resection. (Level of Evidence A) 9. Class IIA Recommendation: Patients with adenocarcinoma who have not received neoadjuvant therapy should be considered for adjuvant chemoradiotherapy if the pathologic specimen reveals regional lymph node disease. (Level of Evidence B). © 2014 by The Society of Thoracic Surgeons.